Zielinski Julie, Oliver Glen, Sybesma Justin, Walter Norman, Atkinson Patrick
Department of Orthopaedics, McLaren Regional Medical Center, Flint, Michigan, USA.
J Trauma. 2009 Jun;66(6):1653-65. doi: 10.1097/TA.0b013e3181a4c0f4.
Hip spica casts (or body casts) are commonly applied to young pediatric trauma and hip dysplasia patients. The greatest hip stability in the cast is achieved via fixed hip flexion or abduction and fixed knee flexion. Unfortunately, this fixed position causes difficulties in restraining children for transport because the child cannot typically accommodate their body to the child car seat geometry. The objectives of the current study were to identify a range of reasonable seating options for casted children. These positions were then studied in frontal crash tests to identify the relative injury exposure for the different positions. A revised casting technique was also investigated in an effort to address head-to-cast contact identified during the course of the study.
The current study assessed the ability for different child seats and the vehicle seat belts to accommodate casted 1-year-old and 3-year-old crash test dummies. The restrained dummies were then subjected to frontal 30-mph crash tests with uncasted dummies serving as a control.
In general, traditional child seats were able to accommodate both children; however, the child's body shifted anteriorly in the cast when the belts were tightened. This shift produced concerns for pulmonary function and the potential for elevated pressure on the superior mesenteric artery. This anterior shift of the chest was reduced when the dummies were restrained by a special hip spica child seat or solely by the vehicle seat belts. When considering all restraint types, the addition of the cast increased the majority of the injury metric magnitudes. For the 3-year-old dummy these increases were determined to be related to the casting technique; an alternative technique significantly reduced the injury metrics.
This study demonstrates that there are anticipated variable effects on basic physiologic function for body-casted children based on the method of restraint. Restraint modalities which place the child forward facing with the face in proximity to the anterosuperior cast overlying the chest should be avoided.
髋人字石膏（或全身石膏）常用于小儿创伤和髋关节发育不良的患儿。通过固定髋关节屈曲或外展以及固定膝关节屈曲，可使石膏内的髋关节获得最大稳定性。不幸的是，这种固定姿势给患儿在转运时的约束带来了困难，因为儿童通常无法使身体适应儿童汽车座椅的几何形状。本研究的目的是确定一系列适合打石膏儿童的合理座位选择。然后在正面碰撞试验中研究这些姿势，以确定不同姿势下的相对损伤风险。还研究了一种改良的石膏固定技术，以解决在研究过程中发现的头部与石膏接触的问题。
本研究评估了不同儿童座椅和车辆安全带对1岁和3岁打石膏碰撞试验假人的适配能力。然后，对受约束的假人进行30英里/小时的正面碰撞试验，未打石膏的假人作为对照。
总体而言，传统儿童座椅能够容纳两个年龄段的儿童；然而，当安全带收紧时，患儿身体在石膏内向前移动。这种移动引发了对肺功能的担忧以及肠系膜上动脉压力升高的可能性。当假人由特殊的髋人字石膏儿童座椅或仅由车辆安全带约束时，胸部的这种向前移动会减少。在考虑所有约束类型时，打石膏会增加大多数损伤指标的数值。对于3岁的假人，这些增加被确定与石膏固定技术有关；一种替代技术显著降低了损伤指标。
本研究表明，根据约束方法的不同，打石膏儿童的基本生理功能会受到预期的不同影响。应避免采用使儿童面部朝前且靠近覆盖胸部的前上石膏的约束方式。
